1
Advancing Technology:
The Impact on Military Medicine
Military Medical Care Symposium, February 11, 2019
Jay J. Schnitzer, M.D., Ph.D., The MITRE Corporation
2
Jay J. Schnitzer, M.D., Ph.D. has no real or
apparent conflicts of interest to report.
Conflict of Interest
3
• Interaction of technology and military medicine
– Importance of clinical pull versus
technology push
• Historical context
• Modern examples
• Global changing landscape of technology
innovation
• Training
Agenda
4
• This session will help healthcare delivery organizations
bridge the digital and technology divide between military
and civilian care settings and determine the appropriate
lessons learned from both that can be applied to improve
outcomes and benefit patients.
• Attendees will gain an understanding of the impact of
advanced technologies development on military medicine,
and the reciprocal examples, and how these can be applied
to other settings, and advance patient care globally.
Learning Objectives
5
• The impact of technology on military
medicine, versus
• The impact of military medicine on civilian
medicine and technology, juxtaposed against
• The impact of technology on civilian medicine
• Clinical pull versus technology push
Interaction of technology and military
medicine
6
Pasteur’s Quadrant
Pure
Basic
Research
Bohr
Use-
Inspired
Research
Pasteur
Unnamed
Pure
Applied
Research
Edison
Practical Use
No
Yes
Fundamental Understanding
Yes
No
7
• Ancient Egypt and Rome
• 16
th
Century France
– 16
th
century: Ambrose Paré
– 18
th
century: Dominique Jean Larrey
Historical perspective (1)
8
• American Civil War Ambulance Corps
• World War II blood banking:
– Dr. Charles Drew
Historical perspective (2)
Portrait of Charles Drew; Associated Photographic Services, Inc - National Library of Medicine:
http://profiles.nlm.nih.gov/ps/retrieve/ResourceMetadata/BGBBCT: Year supplied: ca. 1949 Original Repository: Howard University.
Moorland-Spingarn Research Center. Charles R. Drew Papers; Permission details: Courtesy of the Moorland-Spingarn Research Center.
9
• Korean War MASH units:
3rd Republic of Korea Mobile Army Surgical Hospital,
Wonju, Korea, 1951
• Vietnam War vascular surgery
Recent examples
10
• Information technology
– Electronic health records
– Communications: Smartphones, hand helds
• Robotics / Prosthetics
• Sensors, including smart fabrics
• Non-compressible hemorrhage control
– Novel bandages
– Pro-clotting agents (molecular sieve zeolites)
– Tourniquets
Modern technologies
11
Global changing landscape of innovation
and technology development
12
US R&D Investment 1953-2016
NSF InfoBrief NCSES December 2017 NSF 18-306;
www.nsf.gov/statistics/2018/nsf18306/nsf18306.pdf
13
The pace of technology
14
Technology
Safety
Certification
Acceptance Threshold
Policy
Time
Maturity
15
Technology
Acceptance Threshold
Time
Maturity
Shift the Curves Left!
16
Training
17
Jay J. Schnitzer, M.D., Ph.D.
jschnitzer@mitre.org
Please complete online session evaluation
Questions
18
Advancing Technology: The Impact on Military Medicine Session
February 11, 2019, Glenn Lanteigne, CEO of Tectonic
19
Glenn Lanteigne, MBA, CSSBB
Has no real or apparent conflicts of interest to report.
Conflict of Interest
21
• Canada
– National Defence and the Canadian Armed Forces. Surgeon General’s Integrated Health Strategy – 2017 integration for
better health, 2017.
– Tam-Seto, et al. Identifying military family cultural competencies: experiences of military and Veteran families in Canadian
health care.Journal of Military, Veteran and Family Health, 10 September 2018.
• USA
– The United States Military Health System (MHS) website provides several topics on military health care,
including technology.
– Selected articles:
• Crown, Ellen. Army medical device cyber team balances benefits and risks of technology. Military Health System,
8 November 2018.
• McCaffery, Tom. Transformation underway across the Military Health System. Military Health System, 29 January
2019.
• Suits, Devon. Migration to Defense Health Agency to modernize Army medicine, surgeon general says. Military
Health System, 5 February 2018.
• Further Reference:
– Green, Bruce, Douglas Rosendale and Melissa Majerol. Innovation in the military health system: top 10 emerging
technologies that could yield dramatic improvements. Deloitte Insights, 2018.
– Khan, Saad. Military health system transformation implications on health information technology modernization. Military
Medicine, 183(3), 56-59, 2018.
– Landi, Heather. VA-DoD leaders signal commitment to achieving interoperability, but what uphill challenges will they
face? Healthcare Innovation, 15 October 2018.
– Levin, Dave. VA-DoD: Winning the (Ongoing) Battle for Interoperability. Healthcare Innovation, 22 January 2018.
References
22
More that just Cēpacol
23
.. –. – . ––. .–. .– – .. ––– –.
24
Integration
.. –. – . ––. .–. .– – .. ––– –.
• Morse Code was a means of early communication used for transmitting messages by audible or
visual signals that correlated to each letter of the alphabet.
• Before the invention of Morse Code and the telegraph, messages were still handwritten and
carried by horseback.
• At the time of its invention, it revolutionized communication. Morse Code was especially pivotal
during the second World War because it greatly improved the speed of communication – naval war
ships were able to communicate with their bases and provide critical information to each other; war
planes used
• Morse Code to detail locations for enemy ships, bases, and troops and relay them back to
headquarters.
• Communication tools have come a long way since then, yet effective, clear, targeted and timely
communication remains a challenge in today’s fast-paced and complex organizations – including
ours. The Morse Code on the cover serves to remind us that the successful implementation of an
Integrated Health Strategy requires optimized communication and collaboration, within the Military
and with all stakeholders, as we work toward our shared goal: better health.
25
Philosophy of Medical Care in Canada
• Health, particularly in a military context, is a complex concept unique to
each person, difficult to define, and challenging to operationalize.
• We know that health is not merely the absence of illness, and that there
are many determinants of health such as education, social supports and
employment.
• The Canadian Medical Association considers access to health care and a
health care system to be only 25% of the social determinants of health.
(Figure 1)
• We also know that healthy Canadian Armed Forces (CAF) personnel are
more resilient to both the physical and psychological challenges
expected during a military career.
26
Figure 1 – The Determinants of Health – statistics
provided by Canadian Medical Association, 2015
27
Figure 2 –
Leading
Causes of
Medical
Attrition
(2016)
28
Figure 3 –
Integrated
Health
Strategic
Priorities
29
Technology is a core part of Canadian life today and will continue to be in the future. We must embrace technology and look
for innovative solutions as a way to not only improve how we work and communicate, but to change adverse health
behaviours, provide better advice to CoC and, ultimately, improve the health of all CAF personnel.
30
Innovation in the Military Healthcare System
Top 10
emerging
technologies
that could
yield dramatic
improvements
Source: Deloitte Insight Report 2019
31
Innovation for Defence Excellence and Security (IDEaS)
• Create networks of innovators to conduct leading-edge research and development in areas critical to future
defence and security needs;
• Hold competitions and invite innovators to present viable solutions to specific defence and security
challenges; and
• Implement new procurement mechanisms that allow Defence to develop and test concepts and to follow
through on the most promising ideas.
• $1.6 Billion Dollar Competition
• Over the years, the diversity of the Canadian Armed Forces personnel has helped create a strong, resilient
and flexible military that is able to apply a broad array of perspectives and talents across the spectrum of
operations.
• Under the competitive projects element of IDEaS, four contracts totaling $690K of the $1.6 Billion were
awarded in response to the challenge of how the Canadian Armed Forces (CAF) can recruit, retain and
increase representation of women. The four successful organizations were:
• SkyHive Technologies: “SkyHive Women in the Military
• University of Waterloo: “Improving CAF Gender Diversity”
• University of Ottawa: “A multi-stage approach to addressing sex-disparities in
musculoskeletal injuries in military operators”
• Xtract AI: “Smart recruiting using deep learning”
• These were the first contract awards first call for proposals for the IDEaS program, which received over 600
proposals in response to the 16 defence and security challenges. In the coming months, contract awards for
the remaining challenges will be announced.
32
